Multimodality imaging in COVID19 patient with large mobile RV thrombus protruding into the pulmonary trunk with bilateral pulmonary embolism

Inflammation related to coronavirus disease (COVID)-19 can promote a pro-thrombotic process and subsequent thrombosis. We report a confirmed COVID-19 case in a 51-year-old patient who presented with chest pain and severe hypoxemia. Although the right heart chambers are unusual locations for a thrombus, an echocardiogram demonstrated a large mobile right ventricular thrombus protruding into the right ventricle outflow tract. A computed tomography angiogram and cardiac magnetic resonance image showed the extension of the thrombus into the pulmonary trunk. A continuous intravenous unfractionated heparin infusion resulted in a dramatic clinical and echocardiographic improvement. <Learning objective: With COVID-19 infection, the thrombus phenomenon is becoming more common. Since thromboembolic complications are common in patients with severe COVID-19 who need intensive care unit care, heparin infusion is recommended for patients who are unlikely to need procedures. Multimodality imaging can be useful in determining the diagnosis, prognosis, and treatment plan.>